Outcomes of symptom screening and universal COVID-19 reverse transcriptase polymerase chain reaction testing before endoscopy in a community-based ambulatory surgery center.

Background And Aims: Elective endoscopy resumed in our outpatient ambulatory center after instituting the preprocedure policy of a confirmed negative coronavirus disease 2019 (COVID-19) reverse transcriptase polymerase chain reaction (RT-PCR) status performed 72 hours before a scheduled procedure as mandated by the state of Illinois. In addition, all patients were required to contemporaneously complete the American Society for Gastrointestinal Endoscopy (ASGE) COVID-19 risk screening questionnaire published April 28, 2020 as outlined in the ASGE guidance document for reopening GI endoscopy during the COVID-19 pandemic. The aim of our study is to report the outcomes of 1000 patients who successfully completed the clinical aspects of the ASGE COVID-19 risk screening questionnaire and whose RT-PCR tests were valid for interpretation.

Intestinal Pseudo-Obstruction and Total Villous Atrophy of the Terminal Ileum: An Unusual Presentation of Untreated Celiac Disease.

Intestinal pseudo-obstruction (IPO) is a rare complication of celiac disease (CD) and has often resulted in laparotomy for diagnosis. We report an adult case of CD presenting as IPO with severe protein calorie malnutrition (PCM) and negative endomysial as well as tissue transglutaminase antibodies. This is the first case report of CD presenting with combined IPO, severe PCM, negative first-line celiac serologies, and terminal ileal atrophy that was diagnosed without laparotomy.

Resolution of pancreatico-pleural fistula with endoscopic ultrasound-guided therapy.

Pancreatico-pleural fistula is an uncommon cause of recurrent pleural effusion. Delayed diagnosis may occur if fluid amylase level is not obtained early in the clinical course. As most cases of pancreatico-pleural effusion are due to chronic pancreatitis, endoscopic therapy may be effective if pancreatic fluid secretion can be diverted to a more physiologic pathway.

Risk factors for death or stroke after carotid endarterectomy: observations from the Ontario Carotid Endarterectomy Registry.

Background And Purpose: Carotid endarterectomy is an effective method for preventing strokes if patients do not suffer adverse perioperative outcomes. The purpose of this study was to identify preoperative patient risk factors for adverse outcomes (death or nonfatal stroke) after carotid endarterectomy through the use of a large population-based registry from Ontario, Canada.

Methods: Medical records of all 6038 patients who underwent carotid endarterectomy in Ontario between January 1, 1994, and December 31, 1997, were abstracted from 34 hospitals.

Sex differences in carotid endarterectomy outcomes: results from the Ontario Carotid Endarterectomy Registry.

Background And Purpose: The existing literature provides conflicting evidence on surgical risks of carotid endarterectomy in women compared with men. We used data from a large population-based carotid surgery registry to determine whether sex differences exist in the risk of perioperative complications from carotid endarterectomy.

Methods: We analyzed data from the Ontario Carotid Endarterectomy Registry, which contains data on all patients who underwent carotid endarterectomy in the province of Ontario between 1994 and 1997.

Treatment of corneal surface irregularities using biomask as an adjunct to excimer laser phototherapeutic keratectomy.

Purpose: To assess the clinical changes induced by the use of BioMask as an adjunct to phototherapeutic keratectomy (PTK) using the excimer laser.

Methods: A nonrandomized, prospective clinical trial was conducted. Twenty-two consecutive patients were enrolled for BioMask treatment with reduced visual acuity caused by irregular astigmatism or corneal scarring.

The BioMask for treatment of corneal surface irregularities with excimer laser phototherapeutic keratectomy.

Purpose: To assess the characteristics of BioMask as a potential masking agent for use with the excimer laser.

Method: We addressed ablation rate, smoothness, ease of use, dioptric shift, treatment of standardized irregular topography, and ability of BioMask to induce dioptric change in vivo.

Results: BioMask ablates at a rate of 0.

Determinants of outcome after carotid endarterectomy.

Background: The efficacy of carotid endarterectomy for selected patients has been evaluated with randomized controlled clinical trials. The generalizability of these studies to average surgical practice remains an important public health concern.

Objective: The objective of the study was to determine the predictors of outcome after carotid endarterectomy on a regional basis.

Changing practice and costs of carotid endarterectomy in Toronto, Canada.

Background And Purpose: During our annual audits of carotid endarterectomy (CEA) in Toronto metropolitan hospitals, we have been aware of major changes in the practice of this operation in recent years. To evaluate the effect of changing practice on costs of carotid endarterectomy, we have therefore compared the effects of changes in length of stay, complication rates, and other variables on cost during the last 3 years for which we have complete data.

Methods: We evaluated 757 consecutive patients, of whom 600 had CEA procedures in 3 teaching hospitals, and 190 procedures in 2 community hospitals in metropolitan Toronto.

Comparison of three computerized videokeratoscopy systems with keratometry.

Purpose: To compare the reproducibility of computerized videokeratoscopy systems by using normal eyes and calibrated objects.

Methods: We evaluated the reproducibility of three commercially available videokeratoscopes [EyeSys, TechnoMed C-Scan, and PAR Corneal Topography System (CTS)] with the manual keratometer (Bausch & Lomb) by using calibration spheres and 10 normal subjects (20 eyes). All videokeratoscopy and keratometer results were obtained by one investigator (R.

The Tampa Trephine technique with cat corneal endothelium.

The Tampa Trephine (Martin Marietta Speciality Components, Largo, FL, U.S.A.

Sports medicine. 5. The physiatrist as team physician.

This self-directed learning module highlights important aspects of the evaluation and care of the injured athlete by a team physician. It is part of the chapter on sports medicine in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article covers the components of a preparticipation examination, the on-field evaluation of head, spine, and limb injuries, and return-to-play criteria after specific injuries.

Sports medicine. 2. Upper extremity injuries.

This self-directed learning module highlights recent advances in this topic area. It is part of the chapter on sports medicine in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. In this article, shoulder and elbow problems of the throwing athlete are emphasized.

Sports medicine. 1. The physiatric approach.

This self-directed learning module highlights key elements in this topic area. It is part of the chapter on sports medicine in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article covers the role of the physiatrist in sports medicine and presents an overview of the diagnosis, treatment, and prevention of sports-related injuries.

Long-term versus short-term treatment with recombinant interferon alfa-2a in patients with chronic hepatitis B: a prospective, randomized treatment trial.

We conducted a prospective, randomized trial to study the efficacy and tolerance of long-term versus short-term treatment with recombinant interferon alfa-2a in patients with chronic hepatitis B. Ten patients were randomly assigned to a 6-month interferon regimen, and 10 patients were assigned to a 3-week interferon trial. Eleven patients (five assigned to long-term treatment and six to short-term treatment) did not complete interferon therapy: eight had either severe thrombocytopenia or neutropenia; one had pronounced fatigue in relationship to administration of interferon; one had spontaneous bacterial peritonitis and sepsis and died; and one had a massive fatal variceal hemorrhage during interferon therapy.

Endoscopic laser therapy for watermelon stomach.

Thirteen patients (9 women, 4 men) with anemia from acute and chronic gastrointestinal bleeding were found to have antral vascular disease consistent with watermelon stomach. The median age was 73 yr, with a range of 54-88 yr. Eight of the patients were transfusion-dependent, requiring a median of 5.

L-carnitine: effect of intravenous administration on fuel homeostasis in normal subjects and home-parenteral-nutrition patients with low plasma carnitine concentrations.

We studied the effects of intravenous L-carnitine on the metabolism of fatty acids, ketone bodies, glucose, and branched-chain amino acids in four normal volunteers and four patients on long-term home parenteral nutrition (HPN) with low plasma carnitine concentrations. Substrate kinetics were determined by use of [1-14C]palmitate, [3,4-13C2]-acetoacetate, [6,6-2H2]glucose, and [5,5,5-2H3]leucine before and during a 3-h intravenous infusion of L-carnitine. HPN patients were restudied after 1 mo of nightly intravenous carnitine administration.

Mucosal vascular malformations of the gastrointestinal tract: clinical observations and results of endoscopic neodymium: yttrium-aluminum-garnet laser therapy.

Ninety-three consecutive patients with transfusion-dependent gastrointestinal bleeding from vascular malformations (VMs) underwent systematic assessment in our gastrointestinal laser suite with extended upper gastrointestinal endoscopy and colonoscopy. Of these patients, 83 had angiodysplasia and 10 had the Osler-Weber-Rendu (OWR) syndrome. The median age in each of these groups was 70 and 63 years, respectively.